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Maternal distress during pregnancy related to preeclampsia

  • Siti Nur Khalida ,
  • Erry Gumilar Dachlan ,
  • Gatot Soegiarto ,


Introduction: Maternal distress related to the occurrence of preeclampsia. The distress condition may disrupt the neuroendocrine and immune systems, activating the maternal HPA axis and increasing serum cortisol levels. The latter may affect the placental cortisol lvel, may alter the trophoblast invasion, which is the main pathology of preeclampsia. This study aims to assess the correlation between maternal distress and the incidence of preeclampsia using PSS and DASS-21 questionnaires.

Methods: We conducted a cross-sectional study at two secondary hospitals in Surabaya, East Java, Indonesia from December 2022 until February 2023. Twenty women with preeclampsia and seventeen non-preeclamptic women as control were included in this study. Maternal distress was measured using self-reported PSS and DASS-21 questionnaires.

Results: Preeclamptic women were significantly more depressed and stressed than the control group, while there was no significant difference in anxiety scores between groups. Maternal distress measured by PSS score positively correlated with the occurrence of preeclampsia (p<0,05; β-value 0,742).

Conclusion: Maternal distress conditions were correlated with the occurrence of preeclampsia. Further research still needs to be done to unravel the mechanisms by which maternal distress can induce preeclampsia.


  1. Dahlerup BR, Egsmose EL, Siersma V, Mortensen EL, Hedegaard M, Knudsen LE, et al. Maternal stress and placental function, a study using questionnaires and biomarkers at birth. PLoS One. 2018;13(11):1–18.
  2. Zhang S, Ding Z, Liu H, Chen Z, Wu J, Zhang Y, et al. Association Between Mental Stress and Gestational Hypertension/Preeclampsia: A Meta-Analysis [Internet]. 2013. Available from:
  3. Vianna P, Bauer ME, Dornfeld D, Chies JAB. Distress Conditions During Pregnancy May Lead to Pre-eclampsia by Increasing Cortisol Levels and Altering Lymphocyte Sensitivity to Glucocorticoids. Med Hypotheses [Internet]. 2011;77(2):188–91. Available from:
  4. Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci. 2021 Feb 12;15.
  5. Vehmeijer FOL, Guxens M, Duijts L, El Marroun H. Maternal psychological distress during pregnancy and childhood health outcomes: A narrative review. In: Journal of Developmental Origins of Health and Disease. Cambridge University Press; 2019. p. 274–85.
  6. Togher KL, Treacy E, O’Keeffe GW, Kenny LC. Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling. Psychiatry Res. 2017 Sep 1;255:17–26.
  7. Jahnke JR, Terán E, Murgueitio F, Cabrera H, Thompson AL. Maternal stress, placental 11β-hydroxysteroid dehydrogenase type 2, and infant HPA axis development in humans: Psychosocial and physiological pathways. Placenta. 2021 Jan 15;104:179–87.
  8. Setyorini D, Santoso B, Martini S. Risk Factors of Preeclampsia and Eclampsia in Surabaya [Internet]. Vol. ISSN, Dama International Journal of Researchers (DIJR). Available @; 2017. Available from:
  9. Baibazarova E, Van De Beek C, Cohen-Kettenis PT, Buitelaar J, Shelton KH, Van Goozen SHM. Influence of prenatal maternal stress, maternal plasma cortisol and cortisol in the amniotic fluid on birth outcomes and child temperament at 3 months. Psychoneuroendocrinology [Internet]. 2013;38(6):907–15. Available from:
  11. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong Y. William Obstetrics 22nd Edition. 2005.
  12. Cudihy D, Lee R V. The pathophysiology of Pre-eclampsia : Current Clinical Concepts. J Obstet Gynaecol (Lahore). 2009;29(7):576–82.
  13. Rana S, Lemoine E, Granger J, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094–112.
  14. McEwen BS. Allostasis and Allostatic Load: Implications for Neuropsychopharmacology. Neuropsychopharmacology. 2000;22(2):108–24.
  15. Hux VJ, Roberts JM. A Potential Role for Allostatic Load in Preeclampsia. Matern Child Health J [Internet]. 2014;591–7. Available from:
  16. Shannon M, King TL, Kennedy HP. Allostasis: A Theoretical Framework For Understanding and Evaluating Perinatal Health Outcomes. Journal of obstetric, gynecologic, and neonatal nursing [Internet]. 2007;36(2):125–34. Available from:
  17. Salvador-moysén J, Martínez-lópez Y, Ramírez-aranda JM. The Social Conditions in the Genesis of Preeclampsia. Open J Epidemiol. 2014;4:115–21.
  18. Yu Y, Zhang S, Wang G, Hong X, Mallow EB, Walker SO, et al. The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol. 2013;209(5):438.e1-438.e12.
  19. McEwen BS. Allostasis and the epigenetics of brain and body health over the life course: The brain on stress. JAMA Psychiatry. 2017;74(6):551–2.
  20. Kurki T, Hiilesmaa V, Raitasalo R. Depression and Anxiety in Early Pregnancy and Risk for Preeclampsia. Obstetrics & Gynecology. 2000;95(4):487–90.
  21. Kordi M, Vahed A, Rezaee Talab F, Mazloum S, Lotfalizadeh M. Anxiety during pregnancy and preeclampsia: a case - control study. Journal of Midwifery and Reproductive Health. 2017;5(1):814–20.
  22. Smith AK. Accelerated placental aging in early onset preeclampsia pregnancies identified by DNA methylation. Epigenomics. 2017;9(3):279–89.
  23. Sargent I, Sargent IL, Borzychowski AM, Redman CWG. Article Immunoregulation in Normal Pregnancy and Pre-eclampsia : An Overview. Reprod Biomed Online [Internet]. 2006;13(5):680–6. Available from:
  24. Redman CWG, Sargent IL. Placental Stress and Pre-eclampsia: A Revised View. Placenta [Internet]. 2009;30(SUPPL.):38–42. Available from:
  25. Wang A, Rana S, Karumanchi SA. Preeclampsia: The role of angiogenic factors in its pathogenesis. Physiology. 2009;24(3):147–58.
  26. Karumanchi SA, Bdolah Y. Hypoxia and sFlt-1 in preeclampsia: The “chicken-and-egg” question. Endocrinology. 2004;145(11):4835–7.
  27. Djuanda JK, Akbar MA, Sulistyono A, Aditya R, Ernawati. Impact of preeclampsia on the outcome of COVID-19 infection. Bali Med J. [Internet]. 2023 Apr. 27 [cited 2023 Aug. 15];12(2):1342-6. Available from:
  28. Desetyaputra DR, Prasetyo B, Damayanti HE. Root cause analysis of maternal deaths at Dr. Soetomo General Academic Hospital Surabaya, Indonesia in 2019. Bali Med J. [Internet]. 2021 Oct. 7 [cited 2023 Aug. 15];10(3):874-80. Available from:
  29. Faridah Umamah, Budi Santoso, Esti Yunitasari, Siti Nur Hasina, Raden Khairiyatul Afiyah. Analysis of the characteristics of pregnant women affect nurse interaction with self hypnosis approach in prevention of preeclampsia. Bali Med J. [Internet]. 2023 Apr. 24 [cited 2023 Aug. 15];12(2):1277-82. Available from:

How to Cite

Khalida, S. N. ., Erry Gumilar Dachlan, & Gatot Soegiarto. (2023). Maternal distress during pregnancy related to preeclampsia. Bali Medical Journal, 12(3), 2451–2455.




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Siti Nur Khalida
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Erry Gumilar Dachlan
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Gatot Soegiarto
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